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WPO201700024 Application 2017-03-06
f �-y d Albemarle our v Communit Development' Department 'ntire 401Road Charlottesville, VAM02-4596 Planning PP Application ;e : k434j 2'9o-5832 Fax : (434)972-4126 PARCEL DINNER INFORMATION TMP O56Q0-017-00-03500 Owner(s): LUCKY CREEK LLC Application # r WP0201700024 PROPERTY INFORMATION Legal Description ACREAGE RIDGECRAFT •� Magisterial Dist White Hall Land Use Primary Residential - Single-family (incl. modular homes) Current AFD Not in A/F District �+ Current Zoning Primary RI Residential +� APPLICATION INFORMATION Street Address 659 CRiOZET AVE CROZET, 2.2932 Entered By j-- .application Type Protection Ordinances --t_..y ;Water Project IChesterfield Landing II Received Date 03f 03/17 Received Date Final J Submittal Date 4_ 03/OBJ17 Total Fees 265 Closing File Date Submittal Date Final r n Total Paid 2155 Revision Number Comments Legal Ad SUES APPLICATION(s) _ _ Type .�_ _ SO ram' licatio _ Comment Erosion and Sediment Control Plan 03/03/17 s __.........._....._...._................. ........ ............ ....... ...... ......._.........................................................................:................. _.....,...:................... .:....,......................... ................_..... _....._......................... .............. .....__..........:...,.......................... Stormwater Management/BMP Plan € 03/03/17 APPLICANT / CONTACT INFORMATION - - orta ~t hl a me Audress >r j State Zip Ph«or Pf or eCel l LUCKY CHEEK LLC 362E BLUFTON HILL RD FREE UNION 'VA. 22940 k..... ...... Frim� C-�•+ta st SHIhtP ENGINEERING - ............................ ........ .................. ...... _.-.-......... I ............... I .......... _ ... -...._ .._ ............ ....--.................. .......... .................................... _........................................... -- Signature of Contractor or Authorized Agent 7ete Virginia Stormwater Management Program (VSMP) a Application for Albemarle County i r/iG1l�1A Project Name: Chesterfield Landing 11 (7he name should be the same as it appeals on plans) Is this an amendment to an approved plan? Yes ❑ No 0 Is this a revision or resubmission for review? Yes © No a County File Number: (to be provided by the County for new applications) The following are required elements of new applications (from code section 17-401]. For revisions or amendments, please indicate which items are being amended. Signatures must be provided for any submission. IM A. Signature of the Property Owner for each parcel: (Required with every submission ar revision, NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner, I hereby certify that all requirements of these plans and permits will be complied with, and I have the authority to authorize the land disturbing activities and development on the subject property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure compliance with the approved plans and permits. 56-35 Tax Map & Parcel Print Name of Property Owner Signature of Owner Date Tax Map & Parcel Print Name of Property Owner Signature of Owner Tax Map & Parcel Print Name of Property Owner Signature of Owner Tax Map & Parcel Print Name of Property Owner Signature of Owner Contact Information for the Owner(s) to receive correspondence: Print Address Date Date Date ik City State Daytime Phone E-mail Zip 7/1/14, Revised: 7/10/14, 1/7/14 Page 1 of V. ❑ B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 7.10 Acres to be disturbed Total Fee Fee Due with this Application Fee -with Transfer or modification of permit Less than 1 $290 $145 $20 I and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 For (minor) amendments to an approved plan; $200 per review Variances; $150 (per request) Mitigation Plan; $150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section l 1-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408, ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies ofall plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans wtd�uments: Name of a Contacterson for corresponden (usc� wally the plan preparer, consultant or agent) Print Name Address City State Zip Daytime Phone E-mail *When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 month from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY wPo #b � I—,�,G�}�,, �— y 1 1l-XGi�71� Pt y.J� Fce Amount Datc Paid B tivho Recei # Ck# B ; 7/1 /14, Revised: 7/10/14, 117/I4 Page 2 of 2